Mohs Surgery Wounds: What To Expect

Mohs surgery is the most effective technique to treat common forms of skin cancer such as basal cell carcinoma and squamous cell carcinoma. The Mohs procedure involves the surgical removal of the visible tumor/biopsy site combined with real time examination of the deep and peripheral tissue margins until the Mohs surgeon confirms full cancer removal. 100% of the surgical margins are evaluated yielding the highest success rate in removing skin cancers.

The multi-step process of Mohs surgery means you will be left with the smallest scar possible. What your recovery will look like depends upon the size/depth of tissue removed, the location of the surgery, the quality/tension of the skin and the type of reconstruction procedure performed.

Addressing Wounds After Mohs Surgery

How your physician addresses your wounds following Mohs surgery depends upon many factors including size and location of wound and type of reconstruction. The vast majority of patients will have stitches. Occasionally a wound may be left to heal on its own without stitches.

Leaving the Wound Open

If your Mohs surgery wound is in a place where it can heal well on its own or where scarring is not an issue, it may be left open to heal on its own. If this is the case, follow your doctor’s post-operative care instructions closely to keep your wound clean and free from infection.

Depending upon the size of the wound, full healing could take around 6 weeks. During this time, it’s normal to experience some discomfort, light yellowish discharge, scabbing, and itching as the wound heals.

Stitches

To have the fastest healing time and achieve the best cosmetic result, your Mohs wound likely will require stitches. You will return to your doctor in approximately 7-14 days to have your stitches removed. Occasionally, dissolvable stitches are used.

If you have stitches, keep the area dry for the first 24-48 hours following surgery. Limiting exercise and excessive movement for the first 2 weeks allows the wound to heal with the least amount of scarring and minimizes any potential complications.

Occasionally the Mohs site will need reconstruction with a skin flap or graft. A skin flap covers the wound with neighboring skin tissue, held in place by stitches. A skin graft takes skin tissue from another area of your body and then it is affixed to your wound with stitches.

Bolster Dressing

In the case of a skin graft, you may go home with a special bandage called a bolster dressing, held in place by stitches. The bolster dressing protects the area as it heals and will be removed by your doctor in approximately 7 days at a follow up appointment.

Reconstruction most often takes place at the same time as your Mohs surgery, so you can heal from both procedures together. In some cases, reconstruction may include scar resurfacing or scar revision after your wound has healed.

Home Care After Mohs Surgery

Whether you’ve been sent home with an open wound, stitches or a bolster bandage, you’ll want to manage pain and keep your wound clean and protected. Below are general recommendations for home care after Mohs surgery. As always, we encourage patients to follow their providers specific instructions if they conflict with the following.

Pain

Manage pain with Tylenol and avoid NSAIDs such as ibuprofen or naproxen. If your doctor prescribed pain medication, take it as directed and before pain becomes unmanageable.

Swelling

Swelling and bruising will likely be at its worst for 2-3 days after your surgery, but should subside within a week. To reduce swelling, keep the site of the wound elevated and apply ice for 20 minutes at a time, several times per day for the first few days.

If your Mohs surgery was on your forehead or your nose, it’s normal to experience swelling of the eyelids. If this persists for more than one week, inform your doctor.

Bleeding

Minor bleeding and a small amount of interstitial fluid (yellowish) on your bandages is normal. If bleeding is excessive or does not stop with 20 minutes of firm pressure, call your doctor.

Wound Care

Do not swim, take long baths or otherwise submerge your wound in water until your stitches have been removed. Your doctor will ask you to keep your wound completely dry and to avoid showering for 24-48 hours.

After the first 24-48 hours, removed the bandage and clean the wound daily by running clean soapy water over the site. Pat dry and then apply an ointment such as Aquaphor or Vaseline petroleum jelly and then keep the site covered with a bandage. Repeat this process daily.

Long Term Care After Mohs Surgery

Remember, once you have had skin cancer you are at increased risk for having other skin cancers.

• Limit your time in the sun and do not get sunburned
• When outdoors, cover up with clothing, a wide-brimmed hat and sunglasses
• Use broad spectrum sun protection daily and reapply every 2 hours
• Avoid UV tanning beds

Visit your doctor regularly for re-examination of your Mohs surgery site (and other areas) to be sure there are no signs of recurring cancer or other new skin cancers.

Hubert Chodkiewicz, MD is a board-certified dermatologist and fellowship-trained in Mohs micrographic surgery, cosmetic dermatology, and the treatment of varicose vein disease. He is additionally certified by The American Board of Venous and Lymphatic Medicine. Dr. Chodkiewicz completed his dermatology residency at The University of Texas at Houston/M.D. Anderson Cancer Center where he served as chief resident during his final year.